Use and Transformation of DICOM SR and CDA Release 2 Diagnostic Imaging Reports Helmut Koenig, MD Siemens Healthcare Co-Chairman DICOM WG20 and HL7 Imaging Integration WG

Overview on Presentation Introduction Comparison of Structured Document Standards: DICOM SR vs. HL7 CDA Rel.2 DICOM Reporting Strategy Facilitation of Document Exchange between Imaging and Information Systems Use Cases / Scenarios Scope of SR Transformation Guide / CDA Implementation Guide Conclusions Strategies for Document Exchange April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Acknowledgments Contributions to Documents and Sample Materials: D. Donker, PhD: CDA Sample Document + XSL Stylesheet David S. Channin, MD: Basis for SR Sample Document, Sample Images F. Behlen, PhD, L. Alschuler, R. Geimer : CDA Implementation Guide B. Dolin, MD and Members of HL7 Structured Documents WG: Guidance on CDA Standard April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Introduction Goal: Leverage Communication of Document-Based Imaging Results for Coordination of Clinical Tasks Multiple Specialties in Intra- and Cross-Institutional Settings Provision of Relevant Images, Image-Based Quantitative Measurements and Interpretation Results for Planning Diagnostic and Therapeutic Activities DICOM WG20 is Working on a Pair of Aligned Diagnostic Imaging Report (DIR) Implementation Guides to Harmonize Structured Document Standards DICOM SR / HL7 CDA R2 Transformation Guide CDA Implementation Guide April 8-10, 2008 DICOM International Conference & Seminar

Comparison DICOM SR / HL7 CDA R2 Structure of DICOM SR and HL7 CDA R2: Analysis of SR Basic Diagnostic Imaging Report (Template 2000): Essential SR Imaging Service Data + Context can be represented and mapped to CDA R2. Not only as narrative text, but as structured document content. Minimal Context Information on Subject (Patient/Fetus), Observer (Person/Device) and Procedure has been identified DICOM SR HL7 CDA R2 April 8-10, 2008 DICOM International Conference & Seminar

Comparison DICOM SR / HL7 CDA R2 Scope Imaging Clinical -> Common Data Identified Text Representation Text Content Item Section Narrative Text (Attested Content) + Structured Entries -> TEXT Content Items Map to CDA Entries (Structured Part) Referenced within Narrative Text DICOM Object References Image / Composite Content Items (“Native” DICOM References) Use of WADO References (Web Access to DICOM Persistent Objects) -> DICOM Composite Object Reference CMET Patterns, HL7 V3 Normative Edition 2007/2008 Encoding Binary XML April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Terms & Definitions Evidence Document Uninterpreted Information (Primarily Managed and Used Inside the Imaging Department) Non-Image Information such as Measurements, CAD Results Used in the Process of Creating a Radiological Diagnostic Report Radiological Diagnostic Report Interpreted Information, Primary Output of the Radiology Department “Evidence Documents may be used either as additional evidence for the reporting physician or in some cases for selected items in the Evidence Document to be included in the diagnostic report.” Clinical Document May contain Results and Diagnoses from various Clinical Specialties Radiological Diagnostic Report may be included in the Clinical Document April 8-10, 2008 DICOM International Conference & Seminar

DICOM Reporting Strategy … ... April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Use Cases / Scenarios Inclusion / Transformation: Complete or Partial Document (Minimal Context Information has been specified) DICOM Template Hierarchy Allows for Reuse of Mapped Content for Various Document Types, such as Evidence Documents CDA = Clinical Document Architecture DIR = Diagnostic Imaging Report KOS = Key Object Selection SR = Structured Reporting April 8-10, 2008 DICOM International Conference & Seminar

Materials to Support the Reporting Processes Guidance on the Use and Exchange of SR and CDA DIR Documents Diagnostic Imaging Report (DIR) Transformation Guide CDA DIR Implementation Guide CDA DIR Refined Message Information Model (RMIM) DIR SR and CDA Sample Documents + CDA Stylesheet April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Original CDA R2 RMIM Document Header Related Acts: Encounter, Order, Parent Document… - Participations: PatientRole, Author… Document Body Section with Narrative Text Structured Section Entries Section April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Constrained DIR RMIM Clinical Document Participations mapped except “informant” Related acts mapped except “Consent” and “EncompassingEncounter” (only related Attender Participation) Structured Body NonXMLBody and Section recursive actRelationship (Nested Sections) not used, “informant” not mapped Relevant Clinical Statement Entries: “Observation” (Text and Code), “Procedure” and “Act” entryRelationship Types used: “component”, “reason”, “subject”, “support” Not used: Entry Participations and External References April 8-10, 2008 DICOM International Conference & Seminar

Overview on Mapping of Document Context & Structure DICOM SR HL7 CDA R2 Document Context Information Transformed SR Document ClinicalDocument Original SR Document ParentDocument Preservation of Structural Information Section Level Container Content Item Section Content Items and Relationships CDA Entries and Entry Relationships Participants Author/Person Observer Author Attestor Authenticator Verifying Observer Legal Authenticator … April 8-10, 2008 DICOM International Conference & Seminar

Overview on Mapping of Observation Context DICOM SR HL7 CDA R2 Subject Context Patient recordTarget/Patient Fetus relatedSubject/SubjectPerson Procedure (Diagnostic / Image-Guided Interventions) Procedure ServiceEvent (Document Level), Act/Procedure (Section Entry Level) Order, Requested Procedure Order Observer Person Observer author/assignedAuthor/Person Device Observer author/assignedAuthor/AuthoringDevice April 8-10, 2008 DICOM International Conference & Seminar

Numeric Measurements and Image References CDA R2 Structured Representation DICOM Code 113036 ”Group of Frames for Display” -> April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Conclusions Represention of Essential SR Imaging Service Data and Context Information in CDA R2 is Possible Document and Observation Context Preservation of Structural Information, i.e. for Measurements based on Image Data and their Interpretation Reuse of Identified Patterns for Other Document Types Mapping Supports Communication of Structured Imaging Results and Diagnoses to HL7 Speaking Information Systems Potential Next Steps: Work on Representation and Mapping of Evidence Document Contents Specification of IHE Profile to Define Actors and Transactions April 8-10, 2008 DICOM International Conference & Seminar

References Thank you for your attention ! http://medical.nema.org/ http://www.HL7.org/ http://www.IHE.org/ Thank you for your attention ! April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar Glossary Acronyms: CDA = Clinical Document Architecture DIR = Diagnostic Imaging Report GSPS = Grayscale Softcopy Presentation State KOS = Key Object Selection RMIM = Refined Message Information Model (HL7 Version 3) SOP = Service Object Pair SR = Structured Reporting WADO = Web Access to DICOM Persistent Object (DICOM Part 18) Terms & Definitions: Evidence Document Uninterpreted Information (Primarily Managed and Used Inside the Imaging Department) Non-Image Information such as Measurements, CAD Results Used in the Process of Creating a Radiological Diagnostic Report Radiological Diagnostic Report Interpreted Information, Primary Output of the Radiology Department “Evidence Documents may be used either as additional evidence for the reporting physician or in some cases for selected items in the Evidence Document to be included in the diagnostic report.” Clinical Document May contain results and diagnoses from various clinical specialties Radiological Diagnostic Report may be included in the Clinical Document April 8-10, 2008 DICOM International Conference & Seminar

DICOM International Conference & Seminar DICOM Supplement 101 Includes TID 2005 and Use Cases Text-based Transcribed Diagnostic Imaging Report Includes References to Relevant Images (Conveyed by KOS “For Report Attachment”) in a separate “Key Images” Section DICOM Image References Optional GSPS References for GSPS applied to Images TID 2005 can be transformed to CDA R2 (Subset of TID 2000) April 8-10, 2008 DICOM International Conference & Seminar